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Transcatheter patent ductus arteriosus (PDA) occlusion is one of the safest interventional cardiac procedures among adults and children. However, major adverse events are five to 10 times greater among infants who weigh less than six kilograms, according to a study published August 16 in JACC: Cardiovascular Interventions.

Using ACC’s IMPACT Registry, Carl H. Backes, MD, et al., identified 747 infants weighing less than six kilograms who underwent transcatheter PDA occlusion between January 2011 and March 2015. Across 73 hospitals, the procedural success rate was 94.3 percent, and 96 percent of cases required less than two hours in the catheterization suite.

Regarding the study population, researchers examined differences by grouping the infants into three weight categories: extremely low weight (ELW, <2 kilograms), very low weight (VL, 2-<4 kilograms) and low weight (LW, 4-<6 kilograms). A third of the infants studied were born at <30 weeks of gestation. At catheterization, the median age was 4.3 months and most were LW (4.6 kilograms). Additionally, more than half of procedures were performed on females and Caucasians. Less than half of the infants were hospitalized before the procedure and more than half were on diuretic treatment. Most infants had a Type A (37 percent) or Type C (42 percent) PDA.

While the majority of attempted PDA closures were successful, approximately 13 percent of the infants experienced major adverse events (MAEs). “In the present cohort of infants <6 kg, procedural success rates for transcatheter PDA closure are similar to those in more mature counterparts, but rates of MAE were 5-10 fold greater,” note the study authors.

While the study proves to be an “important first step in understanding the risk profile of transcatheter PDA occlusion in this subgroup of infants,” the authors note that “conclusions on the optimal treatment among lower weight infants with a persistent ductus remain unanswered.”

“Conservative treatment may reduce unnecessary interventions in many infants, but the question remains as to what to do if the PDA fails to close following a period of conservative treatment,” they continue.